Why aren't more MD's recommending or offering neurofeedback?

The answer is straightforward.  It's a lack of education and familiarity.  It's not about efficacy.  There's enough good research and publications around neurofeedback to warrant much wider acceptance.  Clinical success exceeds the research.   But the clinical and research successes are not known by the medical or health community at large - though there is increasing familiarity and openness to it.  What are the obstacles?

Education.  It takes massive efforts and resources to educate physicians about the research, clinical applications and the underlying neuroscience.  For any one new drug - pharmaceutical companies may spend $20 million - or far more. And meds are already familiar.  Neurofeedback has none of those resources.   Without that, and without one or major organization funding education, the education of the medical community will be slow. 

Neurofeedback can't be patented.  That means large capital investments can't be "protected."  It's based on non-proprietary software and hardware.  Major capital has looked into neurofeedback.  So far, they've walked away when they realized there's no way to patent any of the technology or process.  

Without large amounts of funding, it's impossible to pay for the education required - paying fees for speakers, for educational materials, for copies of obscure journal articles, for appearances by experts at major medical conferences. Those efforts require funding that neurofeedback, because of it's non- proprietary nature, doesn't have.  As a result, no experts from the field present at major medical conferences - which is expensive and time consuming.

What about insurance coverage? Admittedly, this is a factor that can slow some health professionals down.  If you work in an area that is all medicaid or medicare, then doing neurofeedback is going to be hard to work with.  But for most clinicians in private practice, some of their patients do have options.   In a healthy practice, those who have added neurofeedback quickly find it pays for itself, even if it's just for a segment of your patient population.   And insurance coverage has improved dramatically over the last 3 years even if it it's not nearly equal to medication reimbursement.

But over the years, it doesn't appear that insurance coverage is the primary issue.  The bigger issues are:

   1. Professionals lack education or access to education about neurofeedback
   2. A lack of peers who have adopted it (the chicken and egg is a powerful force)
   3. INIMJ.  It's not in my journals. The fact that studies appear in smaller specialty journals rather than ""my journal" is often cited as a problem which goes along with point number 2.
   4. Clinicians/MD's are frankly too busy to learn something entirely new.  There's a high comfort level with dealing with pharmaceuticals or psychotherapy.  It's familiar, even when it doesn't work that well. Neurofeedback is not something highly educated MD's and psychologists know anything about.  They didn't study it in school.  This is a major, major impediment.
   5. The healthcare system has a disincentive for innovation.  Does anyone get REWARDED for better outcomes? No.  You only get rewarded for reducing costs.  It's a difficult problem for everyone in the system.

Editorial: At the American Psychiatric Association, Dr. Tom Brod, a psychiatrist and adjunct professor at UCLA and  Mike Cohen organized a presentation for psychiatrists since 2003.  For example, in 2005, three psychiatrists and a psychologist presented on neurofeedback.  In 2006 (Toronto) four psychiatrists, 2 psychologists and a neuropsychologist will present.  All use neurofeedback in their practice.  All paid their own expenses - because of their belief in the importance of this new modality for patients.  None have commercial interests.  They are part of a growing grass roots effort by and for health professionals.

Gaining Wider Acceptance
Neurofeedback would gain wider acceptance if existing research and publications were known.  (click her for highlights of some of the best research).  They aren't.  it requires funding to support broad education efforts. There's nowhere currently that funding will come from.  So the growth - and there is growth, will continue to be a grass roots efforts by professionals and professional organizations to educate the field. There are some vendors, but they are very tiny compared to the large companies that compete to educate health professionals now.